c. Permit for raffle-Triple C 4-H Club

LOCAL PERMIT OR CHARITY LOCAL PERMIT f i OFFICE OF ATTORNEY GENERAL \I ).1 SFN 17926 (06 -2009) 70, Permit Number Type: Local Permit Charity Local Permit 486 Name of Organization Date(s) Authorized (Read instruction 2) Triple C 4 H Club Contact Person Business Phone Number 1/6/2014 1 1/6/2014 Jennifer Nygaard (701) 371 1716 Beginning Ending Mailing Address City State Zip Code 17214 29th Street S. E. Argusville ND 58005 9786 Site Name Site Address Red River Valley Fairgrounds 1351 West Main Avenue City State Zip Code County West Fargo ND 58078 0000 Cass Check the Game(s) Authorized: Poker, Twenty -one, and Paddlewheels may be Conducted only by a Charity Local Permit. 0 Bingo Raffle 0 Calendar Raffle 0 Sports Pool 0 Poker* 0 Twenty -one* 0 Paddlewheels* Restriction: Requirement: For a "Charity Local Permit," the organization must file a "Report on a Charity Local Permit" with the city or county auditor and Office of Attorney General within 30 days of the event. Date Signature of: ID City Auditor County Auditor Printed Name of City or County Auditor Auditor Telephone Number 11/18/2013 Michael Montplaisir (701) 241 -5600 Please see the instructions on the backside of this form on how to complete the Permit. For a raffle or calendar raffle, read "Information Required to be Preprinted on a Standard Raffle Ticket" below. cut along this line INFORMATION REQUIRED TO BE PREPRINTED ON A STANDARD RAFFLE TICKET: 1. Name of organization; 2. Ticket number; 3. Price of the ticket, including any discounted price; 4. Prize, description of an optional prize selectable by a winning player, or option to convert a merchandise prize to a cash prize that is limited to the lesser of the value of the merchandise prize or two thousand five hundred dollars. However, if there is insufficient space on a ticket to list each minor prize that has a retail price not exceeding twenty dollars, an organization may state the total number of minor prizes and their total retail price; 5. For a licensed organization, print "office of attorney general" and license number. For an organization that has a permit, print the authorizing city or county and permit number; 6. A statement that a person is or is not required to be present at a drawing to win; 7. Date and time of the drawing or drawings and, if the winning player is to be announced later, date and time of that announcement. For a calendar raffle, if the drawings are on a same day of the week or month, print the day and time of the drawing; 8, Location and street address of the drawing; g, If a merchandise prize requires a title transfer involving the department of transportation, a statement that a winning player is or is not liable for sales or use tax; 10. If a purchase of a ticket or winning prize is restricted to a person of minimum age, a statement that a person must be at least years of age to buy a ticket, or win a prize; 11. A that a purchase of the ticket is not a charitable donation; 12. If a secondary prize is an unguaranteed cash or merchandise prize, a statement that the prize is not guaranteed to be won and odds of winning the prize based on numbers of chances; and 13. If a prize is live beef or dairy cattle, horse, bison, sheep or pig, a statement that the winning player may convert the prize to a cash prize that is limited to the lesser of the market value of the animal or two thousand five hundred dollars.